Provider Demographics
NPI:1144399098
Name:CENTURY MEDICAL & DENTAL CENTER INC
Entity Type:Organization
Organization Name:CENTURY MEDICAL & DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VALENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-8855
Mailing Address - Street 1:260 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5940
Mailing Address - Country:US
Mailing Address - Phone:718-336-8855
Mailing Address - Fax:718-336-4366
Practice Address - Street 1:260 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5940
Practice Address - Country:US
Practice Address - Phone:718-336-8855
Practice Address - Fax:718-336-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001108R261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02520029Medicaid
NYWEG901Medicare PIN